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Small Business Employee Benefits and HR Blog

FAQ: What is a Qualified Health Plan (QHP)?

Under the Affordable Care Act (ACA) a Qualified Health Plan (QHP) is an insurance plan that is certified by the Health Insurance Marketplace, and meets ACA requirements such as coverage of essential health benefits.

What is a QHP?

QHPs are insurance plans that:

  • Have been certified by the state Health Insurance Marketplace ("Exchange");

  • Provide coverage of essential health benefits;

  • Follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts); and

  • Meet other ACA requirements. 

For example, all QHPs offer the same core set of benefits, including preventive services, mental health and substance abuse services, emergency services, prescription drugs and hospitalization. Some plans include benefits beyond the core set.

QHPs are categorized and labeled by a standard coverage level to help consumers compare plans "apples to apples". The four standard coverage levels ("metallic tiers") are:

  • Bronze: the plan must cover 60% of expected costs for the average individual

  • Silver: the plan must cover 70% of expected costs for the average individual

  • Gold: the plan must cover 80% of expected costs for the average individual

  • Platinum: the plan must cover 90% of expected costs for the average individual

metalic_tiers

There are also catastrophic plans. Catastrophic plans have a high deductible and offer less coverage than the metal level plans. Premium tax credits may not be used with these plans. Consumers must be under 30 or meet other criteria to be eligible to purchase a catastrophic plan.

How to buy a QHP

  • Visit your state's Health Insurance Marketplace (go to HealthCare.gov or see this directory of Marketplace websites)

  • Talk to your health insurance agent or broker. You can also buy a QHP on some private marketplaces or directly from some health insurance carriers.

What questions do you have about Qualified Health Plans (QHPs)? Leave a comment below.

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